I am no authority on tinnitus. I do, however, suffer from chronic severe tinnitus with some hearing loss that has been documented to have been caused by exposure to excessively loud sounds. The loud sounds, in my case, emanated from sirens, air horns, loud diesel motors and other noises that are germane to the fire service.

I was on the job for 33 years, having been hired in 1969. I began to notice a low level of tinnitus-generated sound in about 1982. During the winter of 2000, the tinnitus noise level increased dramatically, causing me great emotional stress and anxiety. The tinnitus is still with me. Through this writing I hope to warn as many firefighters as possible about this insidious, but preventable, malady.

About Tinnitus

When I mention tinnitus, most people tell me that they've never heard of it. Then I'll mention noises in the ears or in the head and most people not only say that they have heard of that, but also say that they have experienced infrequent ringing in the ear or ears that disappears after a few seconds. According to the American Tinnitus Association, "tinnitus is a subjective experience that can be described as chronic ringing, hissing or other noise in the ears and/or head." The word is of Latin origin and it means to "ring like a bell."

Tinnitus can be of little or no consequence to you. However, in extreme cases, tinnitus can be debilitating. It has literally driven some people to insanity and to suicide. It can be like a "gorilla on one's back," said Randy L. Tubbs, Ph.D., formerly of the National Institute for Occupational Safety and Health. "When people think of hearing loss and partial deafness, they immediately think about a quiet world that they will be forced to live in. In some cases, that cannot be further from the truth. Few people realize that noise-induced deafness results in a loud, annoying sound inside one's head that just never quits. It interferes with sleep, watching TV, listening to people, reading a book, almost all facets of daily living. So, loss of hearing does not equal a quiet day of fishing during our retirement years. It can be a screaming inside our heads that never stops."

According to the ATA, approximately 12 million people in this country experience tinnitus so severely that they seek medical help. It is also estimated that another 50 million adults in this country alone have tinnitus to some degree. At the present time there is no cure for tinnitus.

The known causes of tinnitus are many, i.e., ear infection, ear-wax buildup, disorders of the neck vertebrae, jaw problems, allergies, certain medications, cardiovascular problems and high blood pressure. However, one of the most common causes of tinnitus is exposure to excessively loud sounds, especially repeatedly over periods of time. Noise-induced tinnitus is caused by damage to the inner ear's microscopic hair-like nerve endings called hair cells or cilia. Tinnitus is usually associated with some hearing loss in the high-frequency range.

Tinnitus can be made worse by continuous or intermittent additional loud noises; excessive alcohol consumption; caffeine found in coffee, tea, chocolate and soda; nicotine; aspirin and some other drugs; and stress — especially the stresses inherent in the fire service. A firefighter's biorhythms are constantly in flux because our sleep patterns are continually broken. Even when we are "sleeping" during a night shift, that "sleep" is not restful and this has a negative effect on our body's need for rest and rejuvenation. While we are on duty our adrenaline levels are up and are higher during responses. Depending on the incident that we are at, our adrenaline levels can be even higher. This affects our nervous system to a high degree. It is also known as "fight or flight syndrome." According to doctors and medical researchers, high levels of stress and adrenaline will cause the autonomic nervous system to stimulate and aggravate tinnitus. Additionally, loud noises also release more adrenaline, causing an exacerbation of tinnitus. Fatigue also is known to cause tinnitus noise to worsen.

The very nature of a firefighter's work is fertile ground for the development and worsening of tinnitus. Those with tinnitus often times can be in a more irritable mood due to the constant noise that they just cannot evade. Once a firefighter is diagnosed with occupationally noise induced tinnitus and the firefighter remains on regular duty, tinnitus is more difficult to treat for obvious reasons. And the tinnitus will probably get worse. It did for me.

Tinnitus and the Firefighter

Noise-induced hearing loss and inner-ear damage to firefighters (and to other emergency-service workers) has been documented for many years. This occupational damage is commonly manifested by hearing loss that gets worse with the passing of time for the individual. Oddly, very little has been mentioned over the years about tinnitus. Thankfully, that is changing and tinnitus is finally being recognized for what it is and what it can do to firefighters both in terms of physical and psychological damage. The fire service is only just beginning to realize the ravages of tinnitus.

The Federal Emergency Management Agency and the U.S. Fire Administration, in concert with the International Association of Fire Fighters, have produced a document entitled, "Fire & Emergency Service Hearing Conservation Program Manual." This document recognizes the dangers of noise induced trauma to the hearing system and outlines a program to reduce and/or prevent the occupational noise induced hearing damage associated with sirens, air horns, loud motors and other loud noises associated with the emergency services. The following are some excerpts from this document.

"Noise is probably the most underrated health hazard affecting fire and EMS personnel. … The dangers of excessive noise exposure to emergency service personnel are finally being addressed. … The cases of hearing loss are irreversible and incurable. They are also preventable! The effects of noise are cumulative and often take a long time to become permanent and then it is too late. … Noise induced hearing loss is recognized as a significant health hazard throughout the fire services. … Another result of occupational noise exposure is a complication known as tinnitus. It is often associated with hearing loss. This 'ringing' in the ears can become so loud as to disturb one's ability to sleep."

NFPA 1500 and Hearing Damage

To comply with the requirements of NFPA 1500, a fire department must provide hearing protection for all firefighters riding on apparatus who are subject to noise levels above 90 dB. NFPA 1500 considers the use of hearing protection as an interim measure only until engineering controls can be instituted to reduce noise levels produced by vehicles, warning devices and radios…When hearing protective devices are utilized as an interim measure, protective ear muffs are recommended since ear plugs can be difficult to fit and insert. For those fire fighters that must listen to the radio, NFPA 1500 recommends the use of earmuffs with built-in speakers and volume controls for radio and intercom communications.

Hearing protection is required by NFPA 1500. Firefighters often are exposed to noise levels above 90 dB while using power tools or equipment. Finally, NFPA 1500 requires a fire department to establish a hearing conservation program that identifies potential sources of harmful noise and seeks to reduce or eliminate them. A hearing conservation program should address as a minimum, monitoring noise sources, audiometric testing (to be administered in an annual physical and included in a data base), noise-reduction engineering controls, noise-reduction techniques and hearing-protection devices.

According to OSHA standards, the acceptable noise level in the work place is not to exceed 90 dB for an 8-hour period. The action level is 85 dB, which is the level where a hearing conservation program must be offered to employees. Firefighters and other emergency service personnel are often exposed to decibel levels well above 100. A rule of thumb is that if you have to shout to talk to a coworker, noise levels probably exceed OSHA's acceptable noise levels. Noise levels during and at emergency responses/incidents exceed safe decibel levels. If you are not wearing ear/hearing protection during times when decibel levels are high, you are damaging your ears and your hearing.

Other Noise Sources

There are other sources of potentially damaging noises that are subtle and not often thought about.

The use of power tools especially when operated inside of a building or other enclosure where high decibel sounds cannot readily dissipate or be absorbed is an example. Other examples are the in house and apparatus department radios whose volume is turned up loud enough to wake the dead; loud and harsh alert tones broadcast over radios or through microphone speakers on portable radios; TVs and radios whose volumes are turned up too loudly because the firefighters or other emergency personnel are simply either hard of hearing or trying to hear over loud background noises; the momentary high-impact noises of steel forcible-entry tools hitting each other causes sudden high-decibel level noises; PASS devices emit extremely loud noise, but for a good reason. A real Catch 22 issue is the fact that the smoke/fire alarms in buildings can emit a variety of sounds that can be so loud that the sounds distort radio communications on portable radios. Just think of the noise induced damage that is being caused to firefighter's ears when we are in a building where the alarms are sounding loudly and continuously.

Yet another location where loud noise is a major problem is at the street level at the front of a fire building or other emergency incident. Pump operators and incident commanders are subjected to high decibel noises, over extended periods of time, from the sirens and air horns of incoming emergency vehicles, apparatus motors running at high rpms and loud radio chatter.

Our ears and auditory systems are being bombarded with potentially damaging environmental noises. We live in a world of increasing noise pollution. Many of those noises can be controlled and attenuated. Any efforts to reduce loud noises now will produce both immediate and long-term health benefits later in life.

The warning is clear. The proof that loud noises will damage our bodies, permanently is a matter of factual accounts. Losing your ability to hear or hear well is one of the consequences of the inaction to reduce damaging noise levels. The horror of tinnitus is one lesser-known and understood reason to stop the noise.

Robert M. Winston is a retired Boston Fire Department district fire chief, former Pickens County, Ga., fire chief, fire service journalist, and advocate for tinnitus prevention.

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For More Info

The American Tinnitus Association is committed to control and cure tinnitus through the development of resources that advance tinnitus research. To learn more, visit www.ata.org or call 800-634-8978.